OBJECTIVES: Each year 3-5% of Indians develop Type 1 diabetes mellitus (T1DM). Intensified insulin therapy using insulin pumps or MDI are recommended methods. However, insulin pumps are expensive for patients living in middle income countries like India who have to bear high out-of-pocket expense. We conducted a cost-effectiveness analysis to assess the value for money of insulin pumps in Indian settings.

METHODS: Analysis was conducted from societal perspective using a Markov model with time horizon of 8 years. India specific data, wherever available, were extracted, else adopted from comparable economies. Costs and quality-adjusted life years (QALYs) were discounted at a rate of 3.5% annually. Probabilistic sensitivity analysis was performed to assess the robustness of analysis. Model outcomes were reported as incremental cost-effectiveness ratio (ICERs) and cost-effectiveness acceptability curve was constructed.

RESULTS: Insulin pumps had high cost (INR 1286215.08) and high benefits (1.7787). Insulin pump incurred an additional cost of INR 9,78,114.74 to gain an additional year of perfect health. The ICER was greater than three times of India’s Gross Domestic Product (GDP) per capita (INR 1,10,368.91).

CONCLUSIONS: Insulin pumps were associated with better outcomes and higher costs. Insulin pump could be an effective and useful technique provided the patients have lower out-of-pocket expense. Scarcity of India specific data, especially efficacy estimates could have compromised the robustness of analysis.